Phloston

All info in this presentation is high-yield. I had two

questions on my real deal that involved viral

structural identication.

RNA viruses

RNA viruses
Icosahedral or helical nucleocapsids

RNA viruses
Icosahedral or helical nucleocapsids
Icosahedral are either enveloped or non-enveloped.

Helicals are always enveloped.

RNA viruses
Icosahedral or helical nucleocapsids
Icosahedral are either enveloped or non-enveloped.

Helicals are always enveloped.

For icosahedral, non-enveloped viruses, youve got
SS(+) non-segmented and DS-segmented.

RNA viruses
Icosahedral or helical nucleocapsids
Icosahedral are either enveloped or non-enveloped.

Helicals are always enveloped.

For icosahedral, non-enveloped viruses, youve got
SS(+) non-segmented and DS-segmented.
SS(+) non-segmented, non-enveloped icosahedral
viruses are split into picornaviridae and caliciviridae.

RNA viruses
Icosahedral or helical nucleocapsids
Icosahedral are either enveloped or non-enveloped.

Helicals are always enveloped.

For icosahedral, non-enveloped viruses, youve got
SS(+) non-segmented and DS-segmented.
SS(+) non-segmented, non-enveloped icosahedral
viruses are split into picornaviridae and caliciviridae.
Picornaviridae are split into rhinovirus (on its own)
and the enteroviruses.

RNA viruses
The enteroviruses comprise polio, HepA, coxsackie

and echovirus.

RNA viruses
The enteroviruses comprise polio, HepA, coxsackie

and echovirus.
For polio, know anterior horns, superior gluteal nerve
palsy (trendelenburg gait). Contraction of the virus is
THROUGH INGESTION (exceedingly high-yield).
Sabin (oral) is the live-vaccine. Salk (killed) is the IM/
IV vaccine.

RNA viruses
The enteroviruses comprise polio, HepA, coxsackie

and echovirus.
For polio, know anterior horns, superior gluteal nerve
palsy (trendelenburg gait). Contraction of the virus is
THROUGH INGESTION (exceedingly high-yield).
Sabin (oral) is the live-vaccine. Salk (killed) is the IM/
IV vaccine.
HepA Asymptomatic (high-yield), shortest
incubation of the Heps (2-6 wks); killed vaccine

RNA viruses
coxsackieA herpangina (if instead herpes theyll

imply Cowdry bodies via mention of intranuclear

inclusions), hand-foot-mouth disease

RNA viruses
coxsackieA herpangina (if instead herpes theyll

imply Cowdry bodies via mention of intranuclear

inclusions), hand-foot-mouth disease
coxsackie-B most common cause of viral
myocarditis; DIRECT-VIRAL DAMAGE (NOT type-II
HS, like rheumatic heart disease); DCM

RNA viruses
coxsackieA herpangina (if instead herpes theyll

imply Cowdry bodies via mention of intranuclear

inclusions), hand-foot-mouth disease
coxsackie-B most common cause of viral
myocarditis; DIRECT-VIRAL DAMAGE (NOT type-II
HS, like rheumatic heart disease); DCM
echovirus meningitis; theyll tell you kids got
meningitis from RNA virus and then ask you for the
structure (i.e. non-enveloped, ssRNA virus)

RNA viruses
Rhinovirus most common cause of the common

cold (high-% question); contraction occurs via

ICAM-1 (CD54) know that. Sometimes theyll ask
you for the picornavirus thats respiratory-contracted.

RNA viruses
Rhinovirus most common cause of the common

cold (high-% question); contraction occurs via

ICAM-1 (CD54) know that. Sometimes theyll ask
you for the picornavirus thats respiratory-contracted.
For caliciviridae, know calicivirus (Norwalk virus) and
HepE. The catch is that HepE has recently been
reclassied under hepeviridae, so if the latter shows
up, its correct over caliciviridae, but remember both
(just do it; Ive seen both in practice questions).

RNA viruses
USMLE likes Norwalk virus for cruise ships (anything

where a lot of people in close contact come down with

a gastroenteritis).

RNA viruses
USMLE likes Norwalk virus for cruise ships (anything

where a lot of people in close contact come down with

a gastroenteritis).
For HepE, youve just gotta remember pregnant
women (highest yield), Asia > USA (particularly
Tibet), and of course its enteric.

RNA viruses
As we said before, icosahedral, non-enveloped RNA

viruses are either SS(+)-non-segmented or DS-

segmented. For DS-segmented, all you need to
remember is the reoviridae.

RNA viruses
As we said before, icosahedral, non-enveloped RNA

viruses are either SS(+)-non-segmented or DS-

segmented. For DS-segmented, all you need to
remember is the reoviridae.
Reoviridae rotavirus and reovirus (coltivirus)

RNA viruses
Rotavirus is most common cause of viral enteritis in

young children (exceedingly high-yield); USMLE

wants you to know it is HIGHLY SEGMENTED [10]
(like inuenza virus [8]) and therefore can undergo
REASSORTMENT. Theyll ask you for the virus that
can undergo genetic modulation similar to inuenza.

RNA viruses
Coltivirus (reovirus) causes Colorado Tick fever. Ive

never encountered a question on this. But I would be

aware of the viral structure regardless.

RNA viruses
The icosahedral enveloped viruses are SS(+)-non-

segmented and SS(+) diploid. (deltavirus used to be

in this category but has recently been moved to
helical)

RNA viruses
The icosahedral enveloped viruses are SS(+)-non-

segmented and SS(+) diploid. (deltavirus used to be

in this category but has recently been moved to
helical)
SS(+)-non-segmented are togaviridae and aviviridae

RNA viruses
The icosahedral enveloped viruses are SS(+)-non-

segmented and SS(+) diploid. (deltavirus used to be

in this category but has recently been moved to
helical)
SS(+)-non-segmented are togaviridae and aviviridae
Togaviridae are alpha virus (equine encephalitides)
and rubivirus (rubella)

RNA viruses
The icosahedral enveloped viruses are SS(+)-non-

segmented and SS(+) diploid. (deltavirus used to be

in this category but has recently been moved to
helical)
SS(+)-non-segmented are togaviridae and aviviridae
Togaviridae are alpha virus (equine encephalitides)
and rubivirus (rubella)
Flaviviridae are HepC, West Nile, Yellow/Dengue
fevers, Japanese encephalitis

RNA viruses
For the equine encephalitides, theres EEE, WEE and

VEE for Eastern, Western and Venezuelan equine

encephalitis, respectively.

RNA viruses
For the equine encephalitides, theres EEE, WEE and

VEE for Eastern, Western and Venezuelan equine

encephalitis, respectively.
All you need to know for these are that they cause
CNS eects and are associated with horses. Any
mention of horses alphavirus; know the structure.

RNA viruses
For the equine encephalitides, theres EEE, WEE and

VEE for Eastern, Western and Venezuelan equine

encephalitis, respectively.
All you need to know for these are that they cause
CNS eects and are associated with horses. Any
mention of horses alphavirus; know the structure.
For rubella, know that it causes post-auricular or
sub-occipital lymph node tenderness. That will be
the give-away. It also causes a THREE-DAY rash.

RNA viruses
For HepC, be aware that it has the longest

incubation period (in contrast to HepA, which has

the shortest).

RNA viruses
For HepC, be aware that it has the longest

incubation period (in contrast to HepA, which has

the shortest).
Histologically, HepC will cause a nodular or clumpy
appearance; HepB, in contrast, will cause a ground-
glass appearance. Ive seen a question that
mentioned an IV drug-user, and then they showed the
liver histology, and the answer was HepB, not HepC,
and it was strictly because it had a ground-glass
appearance. HepC will be nodular or clumpy, not
ground-glass, despite HepC being more common in
IV drug-users.

RNA viruses
You treat HepC with pegylated interferon-alpha and

ribavirin. Regulater interferon-alpha is Tx for HepB,

not C. If they list pegylated interferon-alpha and
regular interferon-alpha as answer choices to the
same question, if its pegylated, its HepC, not B; if
its regular, its HepB Tx.

RNA viruses
You treat HepC with pegylated interferon-alpha and

ribavirin. Regulater interferon-alpha is Tx for HepB,

not C. If they list pegylated interferon-alpha and
regular interferon-alpha as answer choices to the
same question, if its pegylated, its HepC, not B; if
its regular, its HepB Tx.
HepC is transmitted via blood. That means, it is
NOT TRANSMISSIBLE BY SEX. Obviously if theres
menstruation, theres a risk, but for the purpose of the
USMLE, HepB is transmissible by sex, but HepC is
not.

RNA viruses
Like HepB, HepC is transmitted parenterally, can

cause chronic disease and hepatocellular carcinoma.

The latter will be implied in a question via mention of
alpha-fetoprotein (the tumor marker for HCC; its also
the tumor-marker for yolk-sac [endodermal sinus]
and mixed germ cell tumors).

RNA viruses
If they tell you a patient has HepC (or HepB or

EtOHism), and then they show you a liver with lots

of neoplastic lesions colonic metastases, NOT
primary HCC. So HY. USMLE wants you to realize
that a primary HCC is typically a solitary lesion.

RNA viruses
If they tell you a patient has HepC (or HepB or

EtOHism), and then they show you a liver with lots

of neoplastic lesions colonic metastases, NOT
primary HCC. So HY. USMLE wants you to realize
that a primary HCC is typically a solitary lesion.
Sometimes instead of listing colonic
adenocarcinoma or HCC as answer choices, theyll
just ask for the tumor marker. In the above case, it
would be CEA, not alpha-FP. Alpha-FP is HCC; colon
cancer is CEA.

RNA viruses
For west nile virus, just remember that the pt is

yellow (jaundice) and that he or she has mid-zone

necrosis of the liver (zone-2).

RNA viruses
For west nile virus, just remember that the pt is

yellow (jaundice) and that he or she has mid-zone

necrosis of the liver (zone-2).
For dengue fever, remember that the pt will have
thrombocytopenia, severe back pain, and severe
retro-ocular headache.

RNA viruses
For west nile virus, just remember that the pt is

yellow (jaundice) and that he or she has mid-zone

necrosis of the liver (zone-2).
For dengue fever, remember that the pt will have
thrombocytopenia, severe back pain, and severe
retro-ocular headache.
Ive never seen Sx of Japanese encephalitis asked in a
question before.

RNA viruses
But heres where your points are. So if youve made it

this far in the presentation, heres your reward:

RNA viruses
But heres where your points are. So if youve made it

this far in the presentation, heres your reward:

For the sake of the USMLE, they want you to know
that Japanese encephalitis and Dengue fever are
transmitted by the Aedes mosquito, but West Nile
virus is transmitted by the CULEX mosquito.

RNA viruses
But heres where your points are. So if youve made it

this far in the presentation, heres your reward:

For the sake of the USMLE, they want you to know
that Japanese encephalitis and Dengue fever are
transmitted by the Aedes mosquito, but West Nile
virus is transmitted by the CULEX mosquito.
Seemingly ridiculous, but know it. West Nile virus is
transmitted by the Culex mosquito, and its
reservoir is birds.

RNA viruses
The SS(+)-diploid icosahedral, enveloped RNA viruses

are HIV1/2 and HTLV1/2 (discuss)

RNA viruses
The SS(+)-diploid icosahedral, enveloped RNA viruses

are HIV1/2 and HTLV1/2 (discuss)

HTLV mycosis fungoides / Sezary syndrome

RNA viruses
The SS(+)-diploid icosahedral, enveloped RNA viruses

are HIV1/2 and HTLV1/2 (discuss)

HTLV mycosis fungoides / Sezary syndrome
HTLV also causes TROPICAL SPASTIC
PARAPARESIS. Ive seen this rock up in a question.
Abs against infected T-cells attack neural cells and
cause muscle weakness/stiness in the legs.

RNA viruses
The SS(+)-diploid icosahedral, enveloped RNA viruses

are HIV1/2 and HTLV1/2 (discuss)

HTLV mycosis fungoides / Sezary syndrome
HTLV also causes TROPICAL SPASTIC
PARAPARESIS. Ive seen this rock up in a question.
Abs against infected T-cells attack neural cells and
cause muscle weakness/stiness in the legs.
In Sezarys, youve got Pautrier microabscesses (T-
cell collections). Dont confuse with the Munro
microabscesses of psoriasis (neutrophils in the skin).

RNA viruses
The helical RNA viruses are divided into SS(+) non-

segmented, SS(-) segmented and SS(-) non-

segmented.

RNA viruses
The helical RNA viruses are divided into SS(+) non-

segmented, SS(-) segmented and SS(-) non-

segmented.
The SS(+) non-segmented one is coronaviridae
coronavirus causes SARS

RNA viruses
The helical RNA viruses are divided into SS(+) non-

segmented, SS(-) segmented and SS(-) non-

segmented.
The SS(+) non-segmented one is coronaviridae
coronavirus causes SARS
The SS(-) segmented ones are orthomyxoviridae and
bunyaviridae.

RNA viruses
The helical RNA viruses are divided into SS(+) non-

segmented, SS(-) segmented and SS(-) non-

segmented.
The SS(+) non-segmented one is coronaviridae
coronavirus causes SARS
The SS(-) segmented ones are orthomyxoviridae and
bunyaviridae.
Orthomyxoviridae are the inuenza A, B + C viruses

RNA viruses
Bunyaviridae bunyavirus + hantavirus (mice +

haemorrhagic pulmonary syndrome).

RNA viruses
Bunyaviridae bunyavirus + hantavirus (mice +

haemorrhagic pulmonary syndrome).

The USMLE, for whatever reason, wants you to know
that hantavirus is transmitted by mice. There are
quite a few low-yield viruses, but consider this detail
one of the highest-yield of the low-yield. Ive seen it
in a few questions. Hantavirus is transmitted by mice.
I even have a friend on SDN who had hantavirus show
up on his/her real deal.

RNA viruses
For inuenza, you need to remember that its

HIGHLY SEGMENTED, and that reassortment of the

segments with animal viruses leads to antigenic Shift.

RNA viruses
For inuenza, you need to remember that its

HIGHLY SEGMENTED, and that reassortment of the

segments with animal viruses leads to antigenic Shift.
In contrast, point mutations in haemagglutinin and
neuraminidase lead to antigenic Drift.

RNA viruses
For inuenza, you need to remember that its

HIGHLY SEGMENTED, and that reassortment of the

segments with animal viruses leads to antigenic Shift.
In contrast, point mutations in haemagglutinin and
neuraminidase lead to antigenic Drift.
Youll know its a shift vs drift bc shift causes
PANdemic (worldwide or continental-magnitude
disease), whereas drift causes EPIdemic (towns or
states).

RNA viruses
If they ask about the target of an inuenza vaccine,

the answer is ALWAYS HAEMAGGLUTININ.

Remember that. I talk about this more specically at
the end of this lecture, but haemagglutinin mediates
viral attachment. Vaccines target this molecule.
Neuraminidase inhibitors (-mivirs), in contrast,
prevent viral spread (cells packed with virions).

RNA viruses
If they ask about the target of an inuenza vaccine,

the answer is ALWAYS HAEMAGGLUTININ.

Remember that. I talk about this more specically at
the end of this lecture, but haemagglutinin mediates
viral attachment. Vaccines target this molecule.
Neuraminidase inhibitors (-mivirs), in contrast,
prevent viral spread (cells packed with virions).
They also, once again, want you to remember that
rotavirus, like inuenza virus, is highly segmented.

RNA viruses
The helical, enveloped SS(-) non-segmented ones are

paramyxoviridae, rhabdoviridae, loviridae and

arenaviridae.

RNA viruses
The helical, enveloped SS(-) non-segmented ones are

paramyxoviridae, rhabdoviridae, loviridae and

arenaviridae.
Paramyxoviridae parainuenza virus
(paramyxovirus), pneumovirus (RSV), rubulavirus and
morbillivirus

RNA viruses
For parainuenza virus, remember that it causes

laryngotracheobronchitis (croup), which has a seal-

like barking cough. This causes a steeple-sign on
lateral x-ray (in contrast, epiglottitis causes a thumb-
print sign on x-ray; know that for DDx).

RNA viruses
For parainuenza virus, remember that it causes

laryngotracheobronchitis (croup), which has a seal-

like barking cough. This causes a steeple-sign on
lateral x-ray (in contrast, epiglottitis causes a thumb-
print sign on x-ray; know that for DDx).
For pneumovirus, its aka respiratory syncytial virus
(RSV). Its the most common cause of bronchiolitis
in infants. If theres any pneumonia-type
presentation in an infant RSV; Tx w/ ribavirin.

RNA viruses
For clarication purposes:

Rubulavirus = mumps
Morbillivirus = measles = ruBeola
Those two are paramyxoviridae.
Dont confuse with:
Rubivirus = rubella = German measles = three-day
measles; this is Togaviridae
In addition, roSeola infantum = HHV-6. Dont confuse
with ruBeola, which is measles.
This slide is very important.

RNA viruses
For mumps, just remember MOP: meningitis,

orchitis, parotitis.

RNA viruses
For mumps, just remember MOP: meningitis,

orchitis, parotitis.
For measles, just remember that the rash starts at the
head and moves to the toes.

RNA viruses
For mumps, just remember MOP: meningitis,

orchitis, parotitis.
For measles, just remember that the rash starts at the
head and moves to the toes.
You also need to be extremely aware of subacute
sclerosing pan-encephalitis (SSPE) as a disease
associated with measles.

RNA viruses
For SSPE, youve gotta know that sometimes children

can get measles, the infection resolves, but that the

virus can remain latent in the CNS, only to re-present
later as SSPE. This occurs in M-protein-negative
measles strains, and there will concomitantly be no
evidence of anti-M-protein Abs in the CNS.

RNA viruses
Theyll tell you a 10-yr-old girl was perfectly normal,

but then started doing poorly in school, got

myalgias and then rapidly deteriorated and died.
Theyll ask for which organism is responsible. Its
measles. Youve gotta know this is SSPE. Holy cow.
Id say this is a 240+ question, but its ludicrously HY
and is very commonly asked.

RNA viruses
Theyll tell you a 10-yr-old girl was perfectly normal,

but then started doing poorly in school, got

myalgias and then rapidly deteriorated and died.
Theyll ask for which organism is responsible. Its
measles. Youve gotta know this is SSPE. Holy cow.
Id say this is a 240+ question, but its ludicrously HY
and is very commonly asked.
Or they might tell you a 17-yr-old immigrant had
similar Sx youd need to infer that her immigrant
status means she likely wasnt immunized with MMR
when younger, and she got SSPE subsequently. HY!!

RNA viruses
Another thing: all paramyxoviridae produce F-

protein, which allows them to spread cell-to-cell via

syncytia formation.

RNA viruses
Another thing: all paramyxoviridae produce F-

protein, which allows them to spread cell-to-cell via

syncytia formation.
Palivizumab targets F-protein.

RNA viruses
Another thing: all paramyxoviridae produce F-

protein, which allows them to spread cell-to-cell via

syncytia formation.
Palivizumab targets F-protein.
Youve gotta realize that syncytia formation means
the virus has very little exposure to the humoral
environment. This means very strong CD8+
immunity is needed to kill it. If they ask you for
which virus requires really good intracellular
immunity, you know its any one of the four
paramyxoviridae.

RNA viruses
Filoviridae lovirus subdivided into Marburg +

ebola viruses

RNA viruses
Filoviridae lovirus subdivided into Marburg +

ebola viruses
Arenaviridae lymphocytic choriomeningitis virus
aka lassavirus

RNA viruses
Filoviridae lovirus subdivided into Marburg +

ebola viruses
Arenaviridae lymphocytic choriomeningitis virus
aka lassavirus
Rhabdoviridae lyssavirus (rabies)

RNA viruses
For lyssavirus (rabies), its actually very HY to know

that it looks bullet-shaped on EM. Ive seen this in a

couple questions.

RNA viruses
For lyssavirus (rabies), its actually very HY to know

that it looks bullet-shaped on EM. Ive seen this in a

couple questions.
It also has a very long incubation period (up to several
months).

RNA viruses
For lyssavirus (rabies), its actually very HY to know

that it looks bullet-shaped on EM. Ive seen this in a

couple questions.
It also has a very long incubation period (up to several
months).
Skunks, bats, wild dogs and raccoons are reservoirs.

RNA viruses
For lyssavirus (rabies), its actually very HY to know

that it looks bullet-shaped on EM. Ive seen this in a

couple questions.
It also has a very long incubation period (up to several
months).
Skunks, bats, wild dogs and raccoons are reservoirs.
It ascends MOTOR neurons to the CNS.

RNA viruses
For lyssavirus (rabies), its actually very HY to know

that it looks bullet-shaped on EM. Ive seen this in a

couple questions.
It also has a very long incubation period (up to several
months).
Skunks, bats, wild dogs and raccoons are reservoirs.
It ascends MOTOR neurons to the CNS.
If bit by animal, rst step is IV immunoglobulin,
THEN killed virus vaccine. Ok? IV
immunoglobulin rst (passive immunity), THEN
give the killed vaccine (active immunity).

RNA viruses
The only organism that has a longer incubation period

than rabies is elephantitis (~9 months;

lymphadenopathy), which is Wuchereria bancrofti,
transmitted by female mosquito.

RNA viruses
For ebola/marburg, just know that primates can

transmit the virus and its rapidly fatal. I may have

only seen one question on ebola, and it was pretty
obvious. Realize that the rarer the condition, the
more obvious theyll make the vignette.

RNA viruses
For ebola/marburg, just know that primates can

transmit the virus and its rapidly fatal. I may have

only seen one question on ebola, and it was pretty
obvious. Realize that the rarer the condition, the
more obvious theyll make the vignette.
Ive never seen a question on lymphocytic
choriomeningitis virus (arenavirus) beyond just
knowing its structure and that its rodent-
transmitted.

RNA viruses
All RNA viruses replicate in the cytoplasm EXCEPT

FOR THE LENTIVIRIDAE (retroviruses) AND

INFLUENZA, WHICH REQUIRE THE NUCLEUS.

RNA viruses
All RNA viruses replicate in the cytoplasm EXCEPT

FOR THE LENTIVIRIDAE (retroviruses) AND

INFLUENZA, WHICH REQUIRE THE NUCLEUS.
SS(+) non-segmented RNA viruses are notable for
synthesizing their proteins as a SINGLE
TRANSLATIONAL TRANSCRIPT THAT IS
SUBSEQUENTLY CLEAVED (retarded detail, but Ive
seen it in a question).

DNA viruses (hooray)

DNA viruses
Icosahedral or complex nucleocapsids.

DNA viruses
Icosahedral or complex nucleocapsids.
The only virus with a complex nucleocapsid is

Poxvirus. Its DS-linear and is the only DNA virus

that DOESNT NEED THE NUCLEUS TO REPLICATE.

DNA viruses
For the icosahedral ones, there are non-enveloped

and enveloped types.

DNA viruses
For the icosahedral ones, there are non-enveloped

and enveloped types.

The non-enveloped are SS-linear, DS-circular and DS-
linear.

DNA viruses
The SS-linear icosahedral non-enveloped DNA virus is

erythrovirus (aka parvovirus B19). slapped cheek

appearance; once rash forms VIRUS HAS BEEN
CLEARED AND PARENTS CAN BE TOLD CHILD
DOESNT NEED Tx. Aplastic anaemia in children and
ARTHRITIS IN ADULTS (oh em gee high-yield
wowwies); PB19 crosses placenta (add to TORCHeS)

DNA viruses
How would the USMLE throw the PB19 aplastic

anaemia at you? ..giant red cell precursors seen on

BM biopsy indicative of pure red-cell aplasia. Just
take it as a lesson that on the real deal, theyll take
pretty much any and every concept and indirectly
relate to it, rather than just telling you straight-up.

DNA viruses
Ive also seen in a question that PB19 binds to P-

antigen, aka globoside, on the RBC surface. Dont

confuse that P with that in Palivizumab for F-protein
(syncytia formation in paramyxoviridae theyll ask
you which virus needs super-high CD8 for immunity
bc syncytium means virus doesnt see humoral
environment!).

DNA viruses
The DS-circular non-enveloped icosahedral DNA

viruses are the papovaviridae.

DNA viruses
The DS-circular non-enveloped icosahedral DNA

viruses are the papovaviridae.

These are HPV and JC/BK polyomaviruses. When
PML (JC) appears, the USMLE wants you to know that
its always because of REACTIVATION OF LATENT
VIRUS (holy cow), NOT because of recent infection in
immunocompromised. PML shows up in
immunocompromised so the latter is juicy, but the
former is right. BK aects the kidneys (BK = kidney)
all you need to know about BK.

DNA viruses
For HPV, just know that is causes koilocytes (large,

irregular cells with peri-nuclear halos on Pap-smear)

and cervical cancer. Be familiar with cervical cancer
histology; thats really HY.

DNA viruses
For HPV, just know that is causes koilocytes (large,

irregular cells with peri-nuclear halos on Pap-smear)

and cervical cancer. Be familiar with cervical cancer
histology; thats really HY.
HPV-6/11 cause condyloma acuminata (warts);
HPV-16/18/31/33/45 cause cervical cancer.

DNA viruses
The other thing is that the papovaviridae are

SUPERCOILED circular, whereas HepB (to be

discussed soon) is PARTIAL circular.

DNA viruses
The other thing is that the papovaviridae are

SUPERCOILED circular, whereas HepB (to be

discussed soon) is PARTIAL circular.
As far as I can remember, when PML shows up in a
question, theyll mention it as MANY NON-
CONTRASTING LESIONS on MRI. Ive seen that in a
few questions.

DNA viruses
The icosahedral non-enveloped DS-linear DNA virus

is adenovirus. just remember CONJUNCTIVITIS

and HAEMORRHAGIC CYSTITIS. Conjunctivitis will
be straightforward. For HC, theyll mention a bunch
of kids at daycare with reddish urine and then ask you
for the virus; theyll throw rotavirus in there for kicks
just bc thats so common in infants, but its
adenovirus.

DNA viruses
The enveloped icosahedral DNA viruses are the

herpesviridae and hepadnaviridae (HepB).

DNA viruses
For herpes, they like intranuclear inclusions for

Cowdry bodies. Punched out ulcers is herpes.

Linear ulcers is CMV.

DNA viruses
For herpes, they like intranuclear inclusions for

Cowdry bodies. Punched out ulcers is herpes.

Linear ulcers is CMV.
HepB is enveloped, icosahedral and circular, not
linear.

DNA viruses
For herpes, they like intranuclear inclusions for

Cowdry bodies. Punched out ulcers is herpes.

Linear ulcers is CMV.
HepB is enveloped, icosahedral and circular, not
linear.
HepBs DNA-dependent DNA-polymerase is mega-
high-yield to remember. If they ask you about HepBs
enzyme, the DNA-d-DNA-pol is >>> important than
its reverse transcriptase, but remember both.

DNA viruses
For herpes, they like intranuclear inclusions for

Cowdry bodies. Punched out ulcers is herpes.

Linear ulcers is CMV.
HepB is enveloped, icosahedral and circular, not
linear.
HepBs DNA-dependent DNA-polymerase is mega-
high-yield to remember. If they ask you about HepBs
enzyme, the DNA-d-DNA-pol is >>> important than
its reverse transcriptase, but remember both.
HepD (deltavirus) requires HepB to form envelope;
prevention for HepD is HepB vaccination.

DNA viruses
Remember that for Herpes, they cause Cowdry A

bodies. These are intra-NUCLEAR inclusions. I also

just want to point out that WARTHIN-FINKELDEY
cells, caused by MEASLES, are VERY SIMILAR
histologically to cells w/ herpes-induced Cowdry A
bodies. So be aware of the patients overall
presentation/Hx to make the correct diagnosis.

DNA viruses
HHV1/2 = HSV1/2; HSV1 = herpes labialis (oral),

whereas HSV2 = genital; they can be seen swapped,

but for the purpose of the USMLE, those are the
associations.

DNA viruses
HHV1/2 = HSV1/2; HSV1 = herpes labialis (oral),

whereas HSV2 = genital; they can be seen swapped,

but for the purpose of the USMLE, those are the
associations.
HHV-3 = chickenpox (crops of vesicles on the trunk)
= varicella zoster; can present years later as shingles
(herpes zoster; not a dierent virus, but herpes zoster
is literally the other name for shingles); if shingles
pain (herpetic neuralgia) and vesicles in a
dermatomal distribution. Antivirals discussed later
in this lecture.

DNA viruses
HHV4 = EBV mononucleosis (atypical

lymphocytes on blood smear theyre CD8+ T-

CELLS NOT B-CELLS, DESPITE the virus normally
infecting B-cells) splenomegaly (pt with mono
should avoid contact sports bc spleen is most easily
ruptured abdominal organ, particularly when
enlarged). Can cause Burkitts lymphoma.

DNA viruses
HHV5 = CMV commonly spread via renal

transplantation or blood transfusions; causes

blueberry mun rash + hepatomegaly in neonate if
TORCHeS. CMV colitis occurs in HIV pts w/ <50
CD4+ count; remember linear ulcers. Retinitis is
most common CMV manifestation (CD4+ <200).
Antivirals discussed later in this lecture.

DNA viruses
HHV5 = CMV commonly spread via renal

transplantation or blood transfusions; causes

blueberry mun rash + hepatomegaly in neonate if
TORCHeS. CMV colitis occurs in HIV pts w/ <50
CD4+ count; remember linear ulcers. Retinitis is
most common CMV manifestation (CD4+ <200).
Antivirals discussed later in this lecture.
Remains latent in mononuclear cells (in contrast to
EBV, which remains latent in B-cells)

DNA viruses
HHV6 = roseola infantum = spiking fever followed by

rash. Thats all you need to know about it.

DNA viruses
HHV6 = roseola infantum = spiking fever followed by

rash. Thats all you need to know about it.

HHV8 causes Kaposis sarcoma in HIV pts
(abnormal endothelial/vascular proliferations
histologically), body-uid lymphoma, and
Castlemans disease (non-cancerous lymph node
growths). Kaposis can occur in the GIT blood in
stool. Bacillary angiomatosis (caused by bartonella
henselae) can cause Kaposi-like lesions, except there
will be neutrophils on biopsy instead of the vascular
proliferations dont **** that up.

DNA viruses
Youve gotta know that all viruses derive their

envelopes from the cell membrane, but herpesviridae

GET IT FROM THE NUCLEAR MEMBRANE.

DNA viruses
Youve gotta know that all viruses derive their

envelopes from the cell membrane, but herpesviridae

GET IT FROM THE NUCLEAR MEMBRANE.
Youve also gotta know that dsDNA and SS(+)RNA
viruses are infective VIA PURIFIED NUCLEIC ACID
ALONE theyll ask you this to see if you
understand the molecular biology

An3virals
Amantadine blocks viral uncoating; mutated M2

protein = resistance; can cause ATAXIA; can be used

for Parkinsons disease, rubella and inuenza;
RImantidine has fewer CNS side-eects bc it doesnt
cross the BBB. Youve also gotta know that antivirals
reduce the length of Sx by 1-1.5 days. Ive seen this
in a question where reduce Sx duration by half was
also an answer choice.

An3virals
For oseltamivir / zanamivir, theyll tell you that a med

was given and now the cells are lled with virions.
prevent viral release; theyll also ask you for which
drug prevents the spread of virus the best, and the
mivirs are right. Theyre SIALIC ACID ANALOGUES.
Youve gotta know haemagglutinin and
neurominidase, where sialic acid is cleaved by the
latter for release. If they ask about the target of the
best vaccine, the answer is ALWAYS
HAEMAGGLUTININ (exceedingly high-yield).

An3virals
Ribavirin is used for HepC and RSV. high-yield.

Ive also seen in a question that ribavirin CAUSES

HAEMOLYTIC ANAEMIA. Thats in FA too btw.
Ribavirin inhibits IMP dehydrogenase. UWorld went
into extensive detail about ribavirin mechanisms, but
the extent that is important is that there is decreased
IMP to GMP conversion.

An3virals
Acyclovir HHV1-4; guanosine analogue. Just know

that HHV1-4 phosphorylate the drug to the

monophosphate. Cellular kinases then bring the
G*MP to the G*TP form. HHV1-4 resistance is due to
LACK (NOT ALTERED) OF VIRAL THYMIDINE
KINASE. Ive seen altered kinase and lack of kinase as
answers to the same question; the latter is the real
deal and also in FA. Acylcovir (not oral) decreases
LENGTH of outbreak; daily oral VALacyclovir
decreases RECURRENCE of outbreaks. USMLE wants
you to know that the drug causes CHAIN
TERMINATION. FAMcyclovir is for shingles (HY).

An3virals
Ganciclovir is for CMV (HHV5).
Ultra high-yield: CMV has increased susceptibility to this

drug bc of DIFFERENT DNA POLYMERASE STRUCTURE.

Mechanism of phosphorylation similar to w/ acyclovir.
Side-eects for this drug are EXCEEDINGLY HIGH-Y.
NEUTROPENIA (and leuko-/thrombocytopenia) is the big
one. Theyll give you a vignette of someone with a drop in
grans whos taking an anti-viral (wont be obvious at all, so
remember the neutropenia). They could even be tricky
and ask for what was being treated (so youd have to know
the drop in grans was bc of ganciclovir, that CMV must
have been the organism treated, and that the pt may have
had retinitis/colitis).

An3virals
Foscarnet just know this is for ganciclovir-

refractory CMV. Like ganciclovir, its side-eects are

ultra-HY:
NEPHROTOXICITY and HYPOCALCAEMIA, -
KALAEMIA, -MAGNAESEMIA. Crazy HY.
Its a pyrophosphate analogue, so it doesnt require
the initial phosphorylation that ganciclovir does.
Theyll ask you this.
Cidofovir is in FA, but Ive actually never seen it rock
up in a question. Just know that it also is nephrotoxic
and doesnt need the initial phosphorylation, so its
used for acyclovir-refractory illness.